1. (a) For purposes of meeting the requirements of Insurance Code Section 12693.41 relating to the Healthy Families Program reimbursements, a “CHDP well-child health assessment” is as defined in Title 17, California Code of Regulations, Section 6800 and shall include those services specified in Title 17, California Code of Regulations, Section 6846.

2. (b) For purposes of meeting the requirements of Insurance Code Section 12693.41 relating to the Healthy Families Program reimbursement, “initial treatment” means those services provided in the 90 days prior to a person's effective date of coverage by a Healthy Families Program participating health plan that are necessary for diagnosis and treatment of a condition identified during the “CHDP well-child health assessment”. These services may include, but are not limited to:

   1. (1) Outpatient physician services including referral to outpatient specialty care, laboratory services, x-ray services, prescription drugs and those medical supplies and equipment necessary to administer prescribed medication.
   2. (2) Inpatient hospital care.
   3. (3) Emergency dental services that are medically necessary for the relief of pain and treatment of infection.

Note: Authority cited: Section 12693.21, Insurance Code. Reference: Section 12693.41, Insurance Code.

History

1. New section filed 8-28-98 as an emergency; operative 8-28-98 (Register 98, No. 35). A Certificate of Compliance must be transmitted to OAL by 12-28-98 or emergency language will be repealed by operation of law on the following day.

2. Certificate of Compliance as to 8-28-98 order, including amendment of subsection (b)(3), transmitted to OAL 12-18-98 and filed 2-2-99 (Register 99, No. 6).

3. Amendment of subsection (b) filed 1-10-2000 as an emergency; operative 1-10-2000 (Register 2000, No. 2). A Certificate of Compliance must be transmitted to OAL by 5-9-2000 or emergency language will be repealed by operation of law on the following day.

4. Certificate of Compliance as to 1-10-2000 order transmitted to OAL 5-5-2000 and filed 6-16-2000 (Register 2000, No. 24).